Ucsf: Video H 69 Part 3 Diffuse Airway Disease (Nodules)

Front 1

What are the 3 patterns of nodules that are seen on HRCT?

Back 1

perilymphatic
random
centrilobular

Front 2

Where are the nodules seen in perilymphatic distribution
3

Back 2

around the lymphatics: subpleural, peribronchovascular, interlobular septa

Front 3

What is the overall appearance of perilymphatic nodules

Back 3

patchy

Front 4

What is the cause of perilymphatic nodules in 95% of cases

Back 4

sarcoid

Front 5

What is the ddx for perilymphatic nodules
6

Back 5

sarcoidosis
lymphangitic spread of tumor
silicosis
CWP (ooal workers pneumoconiosis)
amyloidosis
LIP (lymphoid interstial pna)

Front 6

What percent of patients with sarcoid have mediastinal nodes

Back 6

60-90%

Front 7

Are the nodes symmetrical in sarcoid?

Back 7

yes

Front 8

Is hilar adenompathy also common in sarcoid

Back 8

yes

Front 9

What percent of sarcoid is actually seen on plain film?

Back 9

50%

Front 10

Name 3 types of pneumoconiosis

Back 10

CWP
asbestosis
silicosis

Front 11

What is the most common type of hypersensitivity pneumonitis?

Back 11

bird fanciers or farmers lung (from mold)

Front 12

What part of the lung does sarcoid tend to effect predominately

Back 12

upper lung zones

Front 13

What is the galaxy sign in sarcoid?

Back 13

large upper lobe mass with surrounding satellite nodules

Front 14

What happens in late stage sarcoid
4

Back 14

upper lobe fibrosis, fibrotic masses , traction bronchiectasis, cyst, emphysema

Front 15

What is the 1-2-3-4 sign

Back 15

right paratracheal, right hilar, left hilar, left aorticopulmonary window

Front 16

What causes the large mass in sarcoid?

Back 16

a congoleration of perilymphatic nodules

Front 17

Can late sarcoid cause large cystic lesions in the upper lobes

Back 17

yes

Front 18

Can an aspergilloma end up in one of these large sarcoid cyst

Back 18

yes

Front 19

What pneumonconiosis may cause similar symptoms to sarcoid

Back 19

silicosis (perilymphatic)

Front 20

Can the galaxy sign be seen in silicosis

Back 20

yes

Front 21

Does silicosis have an upper lobe predominance

Back 21

yes

Front 22

What is seen in end-stage silicosis

Back 22

upper-lobe fibrotic masses

Front 23

Can sarcoid and silicosis be difficult to differentiate

Back 23

yes

Front 24

When are Egg shell calcification typically seen

Back 24

silicosis, sarcoid and TB

Front 25

Are random nodules ever subpleural

Back 25

yes, but not as much as in perilymphatic

Front 26

What are three characteristics of random nodules

Back 26

random
uniform distribution
subpleural

Front 27

What is the ddx for random nodules
4

Back 27

miliary tb
miliary fungal infections
hematogenous mets
sarcoid

Front 28

Is sarcoid commonly random

Back 28

no

Front 29

Can you see miliary tb on cxr

Back 29

yes

Front 30

If a pt has random nodules and HIV what should be suspected

Back 30

miliary cocci or miliary tb

Front 31

What are the characteristics of centrilobular nodules

Back 31

they occur in the centrilobular are of the secondary lobules by the centrilobular bronchiole or artery

centered 5-10mm from the pleura

evenly spaced

Front 32

What is the similarity between random nodules and centrilobular nodules

Back 32

they both may be uniform

Front 33

Can centrilobular nodules be diffuse or patchy

Back 33

yes

Front 34

What type of nodules will you suspect if there is subpleural nodules

Back 34

random and perilymphatic

Front 35

What if you see nodules that are subpleural, patch or non-uniform?

Back 35

perilymphatic and sarcoid, silicosis or lymphangitic carcinoma would be suspected

Front 36

What if you see diffuse and uniform pattern of nodules and also subpleural nodules

Back 36

random nodules (milliary TB, hematogenous Mets)

Front 37

What if you see no pleural nodules

Back 37

centrilobular nodules

Front 38

What type of nodular pattern will a hypersensitivty give?

Back 38

centrilobular

Front 39

What is the ddx of centrilobular nodules
9

Back 39

bronchiolitis
endobronchial spread
bronchopneumonia
HP
endobronchial spread of tumor
pneumoconiosis (silicosis)
edema (uncommon)
hemorrrhage (uncommon)
vasculitis (uncommon)

Front 40

What two types of patterns can silicosis give

Back 40

perilymphatic (MC) or centrilobular (uncommon)

Front 41

What are two types of causes of bronchiolitis

Back 41

infectious or inflammatory

Front 42

What is the mcc of centrilobular nodules

Back 42

bronchiolitis

Front 43

Is the centrilobular distribution with bronchopneumonia usually patchy

Back 43

yes

Front 44

What is the nodular distribution of non-miliary TB?

Back 44

centrilobular

Front 45

What should you suspect if there are centrilobular nodules and a cavitary lesion

Back 45

TB

Front 46

What should you suspect if there is centrilobular nodules, and GGO?

Back 46

BAC

Front 47

What causes the tree in bud appearance

Back 47

dilatation and impaction of the centrilobular airway

Front 48

What makes up the buds of the tree in bud

Back 48

the centrilobular nodules

Front 49

What makes up the tree of the tree in bud sign

Back 49

the dilated and impacted centrilobular airway

Front 50

What does a tree in bud sign mean

Back 50

there is an infectious cause (specific)

Front 51

What is the ddx of the tree in bud sign
9

Back 51

endobronchial spread of TB or MAC
bronchopneumonia
bronchiestasis or bronchitis
CF
aspiration (rare)
ABPA or asthma (rare)
BAC (rare)

Front 52

What are 4 rare causes of the tree in bud

Back 52

aspiration
ABPA or asthma
BAC